Richard Kekuni Akana Blaisdell is a professor of medicine at the University of Hawai'i, in Honolulu and is a co-founder of E Ola Mau, an organization of Hawaiian health professionals. His research interests include the spleen and blood disorders, the history of medicine, Polynesian medicine and Hawaiian health. He is also on the board of Ke Ola Mamo, convenor of the Pro-Hawaiian Sovereignty Working Group and coordinator of Ka Pakaukau, a group of twelve organizations seeking independence.

Historically, traditional kanaka maoli lapa'au (Hawaiian medicine) may be considered in three periods: (1) the pre-Western over 1 500-year era, beginning with the arrival of the first Polynesians from South Oceania who settled in Hawai'i about 100 A.D., until the 1778 chance-arrival of the first European explorers. (2) The period of Western contact with the introduction of European-American and Asian diseases and ways, cultural conflict, subsequent 1893 illegal U.S. armed invasion and 1898 U.S. forced annexation of Hawai'i. (3) The modern period of further de-Hawaiianization and coercive, Western assimilation up to the 1985 E Ola Mau Native Hawaiian Health Needs Study Report re-awakening interest in, and support for, lapa'au. *1

In pre-haole (pre-Western) Hawai'i before Cook's arrival in 1778, lapa'au was organized locally to meet local needs.*2 Each kanaka maoli (indigenous Hawaiian) as a child learned to be self-sufficient living off of the land and the sea. But each native also always shared with others in the ahupua'a geographical unit which extended from the ocean to the inland mountain ridge. The essence of wellness was lokahi (oneness) and pono (harmony) with self, others and all in the cosmos. Lokahi was inherent, having resulted from the mating of sky father Wakea with earth mother Papa. Since all things had this common parentage, all things were also living, conscious and communicating siblings.*3

Human anatomy also reflected spiritual relationships, such as in the concept of na piko 'ekolu (three body points): *4 (1) Piko po'o or manawa at the top of the person's head, also evident as the open fontanel in the infant's skull, was the opening that connected the individual's 'uhane (spirit) with the spiritual realm beyond, including one's 'aumakua, departed but ever-present deified ancestors, since the beginning of time. (2) Piko waena, or the navel, represented the remnant of the person's intrauterine umbilical connection to his parents in the contemporary world. This piko covered the na'au (gut) which was the seat of knowledge, wisdom and emotions. (3) Piko ma'i was the genitalia, which linked the person to his descendants forever into the future.

In spite of this prevalent spirituality, all was natural. There was nothing supernatural in the Western sense. Events could, and were, influenced by all of the numerous forces in the material and spiritual realms, favorable and adverse, and from the past as well as the present and into the future. These forces included each kanaka's thoughts and attitudes, as well as his actions.*5

Palua (dualism) of complementary opposites was recognized, such as sky and earth, sun and moon, day and night, male and female, right and left, hot and cold, fire and water, spiritual and material, good and evil, health and illness, and life and death.*6
Pono (harmony) was maintained by proper thoughts, feelings and actions toward the spiritual as well as the material world. Misfortune, such as ma'i (illness) resulted from altered pono or impaired relationships and loss of mana (special energy). Wellness was restored by correcting impaired relationships through communication with spiritual forces and healing thoughts and actions. Uses of la'au (plant), animal and mineral materials were effective because of their spiritual and metaphorical mana.*7

If the individual's efforts at healing were not effective, the 'ohana (family) elder's intervention was sought. If this too was not of benefit, the problem was taken to the kahuna lapa'au (medical practitioner-priest) at the nearest heiau ho'ola (healing temple), if the patient's status and resources were sufficient.*8

In all of Polynesia, only in Hawai'i were there such heiau ho'ola for: (1) training of haumana (students) with a rigorous 20-year or so curriculum; (2) research, with development of simple surgery, fracture-setting, clyster enema, thermo-helio-therapy, and la'au (medicinal plants); (3) special practices, such as cultivation, gathering and preparation of la'au (medicines), ho'ohapai and ho'ohanau keiki (induction of pregnancy and baby-delivery), pa'ao'ao (child care), 'o'o (simple surgery), h-ah-a (palpation), lomilomi (massage), ha'iha'i iwi (bone-setting), ka'alawa maka and 'ike lihilihi (close observation), k-ahea and makani (calling and engaging spiritual forces); 'ana'ana, kuni and ho'opi'opi'o (engaging adverse and counter-adverse forces).*9

Pu'uhonua (sanctuaries) contained healing power and were of several varieties: (1) sacred sites, such as Pu'uhonua o Honaunau, which included the home of the ruling ali'i (chief) and adjacent heiau which housed the iwi (bones) of previous ruling chiefs, and Kukaniloko, ali'i birthing place in Wahiawa, O'ahu;' *10 (2) the ruling ali'i himself, such as Kamehameha, and specified members of his court, such as Ka'ahumanu; *11 (3) ho'ola kanawai (sacred healing laws), such as kanawai mamalahoe; *12 and (4) Pohaku o K-ane (stone of Kane) for each 'ohana (family).*13

'Ana'ana were psychospiritual methods of influencing, or explaining, events that might be unfavorable to some while favorable to others. Misnamed "sorcery" or "black magic" by haole (Westemers), and denounced by them and some early native writers, these techniques were employed by special classes of kahuna. *14

The above-described highly-organized, yet locally-based system was threatened in 1778 by the fatal impact of epidemics of foreign contagious infections, beginning with gonorrhea, syphilis, tuberculosis, then pneumonia, influenza, measles, mumps, typhoid and other infectious diarrheas, smallpox, and later leprosy, plague, diphtheria and the streptococcoses. *15

Traditional lapa'au could not stem the devastation. Nor was Western or Asian medicine effective.*16 Other factors contributing to the over 95% decline in the native population, from an estimated 800,000 in 1778 to 40,000 in 1893, were: colonial economic and political exploitation, a market and money economy, private ownership and thus loss of lands, and economic dependence; repression of kanaka maoli culture, education, language, and spirituality; cultural conflict, stress and despair; adoption of harmful foreign ways, such as the use of alcohol and tobacco, less physical activity, and the Westem high-saturated fat, high-cholesterol, high-salt and low-fibre diet. *17

Homeless urban kanaka maoli suffered most. Rural natives, retaining their close spiritual and physical relationship to the land and sea, fared better. Unable to afford haole medicine, they refined their uses of native plants and adopted newly-introduced folia in their treatment of foreign infections and "degenerative" diseases of Western civilization, such as heart and kidney failure, diabetes, hypertension and cancer, in spite of scorn and suppression by the dominant haole society. *l8

In 1865 Kamehameha V and in 1879 Kalakaua attempted to revive traditional lapa'au by the issuing of government board licenses to kahuna "to practice native medicine." *19 However, these practices were largely limited to herbal medicine and lomilomi. Traditional 'ana'ana and related methods were officially banned, but remained underground. Christian prayers and varieties of ho'oponopono ('ohana spiritual group therapy) replaced pre-Western rituals and ceremonies. *20

Wlth the U.S. armed invasion of 1893, and the 1898 illegal U.S. annexation and occupation, an official policy of coercive assimilation and de-Hawaiianization ensued with further suppression of lapa'au. *21 Although the 1919 Territorial legislature authorized a Hawaiian Medicine Board to issue licenses to herbalists, two of the three board members were haole who required the kanaka practitioner applicants to use Western scientific names for native medicinal plants in the certifying examination. *22

In 1965 the examining board was abolished because the statute authorizing it and licensure of traditional practitioners were considered "obsolete." Kanaka Maoli herbalists were no longer recognized, while lomilomi practitioners had to be certified by a separate, albeit still legal, Board of Massage. *23 Thus, kanaka lapa'au practitioners were again compelled to go underground.

In the 1980s mounting restlessness in kanaka communities led to several investigations including the 1985 E Ola Mau Native Hawaiian Health Needs Study Report. *24 Publicly documented was the worst health plight of kanaka maoli compared to the other ethnic groups in our homeland. In 1986 a small nucleus of kanaka maoli health professionals, who had participated in the E Ola Mau Study, founded a permanent organization-E Ola Mau (Live On!) to reverse the health tragedy of our people. One result was the Native Hawaiian Health Care Act of 1988. This U.S. Congressional legislation called for: (1) maximum participation by kanaka maoli, including traditional lapa'au heal- ers, (2) Native Hawaiian health centers/systems established by Native Hawaiian organizations throughout Hawai'i for health promotion, disease prevention and primary health care; (3) an overseeing Papa Ola Lokahi five-member board consisting of E Ola Mau, state Office of Hawaiian Health, Office of Hawaiian Affairs, Alu Like, and the University of Hawai'i; (4) $19.6 million authorized over three years, with $700,000 appropriated in 1990-1991 for planning, but only $2.3 million in 1991-1992 for beginning health services.

Encouraged by E Ola Mau in 1986 and by the 1988 Native Hawaiian Health Care Act, traditional lapa'au healers have re-emerged from "the bush." They have conducted dozens of educational workshops, and are still attempting to organize themselves independently to become officially recognized, develop standards of competence and to pass on their knowledge and skills to future generations. These practitioners contend that "akua heals, not the practitioner," that a holistic approach to the entire 'ohana of the patient is necessary, and that spiritual communication is basic. Some practitioners still refuse to accept monetary payment for their services, insisting that theirs is a gift to be shared. Some see "no need" for certification, licensure and liability insurance. They fear control by an imposed foreign government. For the state has arrested la'au-gathering practitioners for "trespassing," and is promoting commercial development, and thus destruction, of our land and ocean resources.

Three options are now apparent: (1) remain underground at the risk of becoming another lost treasure of the old heritage; (2) submit to control by the commerce-oriented, dominant Western society; (3) assert kanaka maoli control of our land and ocean resources. These resources are essential for our livelihood and survival as the first people in our homeland with a distinctive culture in which spiritual affiliation and sharing are paramount rather than individualism, exploitation, materialism, waste and destruction of our natural environment.

This paper was presented August 24, 1991, at a panel on Pu'uhonua in Hawaiian Culture, sponsored by Kahua Na'auao, and supported by a grant from the Hawai'i Committee for the Humanities.